CPAP vs APAP - one sleep doc's view

[roztom]

TO clarify my previous post:

THis AHI/Pressure chart says a lot. I would like to know what the 90% pressure was at in Encore Pro at the time of Derek's study.

Tnx,

Tom

[Guest]

If we can assume derek presented all his own data in the MyEncore tutorial (as the identical date ranges would indicate), then this graph gives you your answer.

Cumulative Pressure Distribution: This plot is most useful for APAP treatment. It basically contains the same information as the straight pressure plot, but adds the hours spent at the given pressure and all pressures below that pressure, and then expresses the answer as a fraction of the total number of hours in the date range. The plot is similar to the one generated in the Encore Pro report. It may be used to find the average treatment pressure (50%) and the ninety percentile pressure (90%).



From the above plot we can see that 90% of the time the APAP pressure was below 10.5 cm, and the average pressure was about 8.5 cm H2O.

To see all his coinciding graphs, click on this link: MyEncore

[Goofproof]

The only problem is it's his dogs data.

[Guest]

A very interesting discussion. Some comments:

1) An APAP machine can always be set to run in CPAP mode, so it's still a good choice even if the sleeper's doctor thinks CPAP is enough.

2) If variations in pressure "confuse" the brain, causing more events, it may be the different CO2 levels caused by differences in the effectiveness of the mask's CO2 venting at the different pressures, rather than the small difference in pressure (assuming the range is set narrow, as it should be). Too bad there isn't an easy way of adjusting venting "on the fly." Until there is, it just provides another reason for keeping the APAP's range set fairly narrow.

3) An APAP with optional software can be used to find the optimal pressure, or, in my case, narrow range of pressures; and then provide constant monitoring of how one is doing. Straight CPAPs usually don't provide the data that an APAP collects or encourage the "hands on" attitude that an APAP can.

4) An APAP can compensate somewhat for abnormal situations, such as position problems and nasal congestion, that one probably wouldn't want to set a CPAP high enough to handle.

5) When the AHI's are all relatively low (as in the chart study above), it's hard to know, without more, whether the lower AHI represents the best result. At least in my case, using an oximeter, I have found that I can suffer worse desaturations on nights when I experience lower AHI's.

[ozij]

Straight CPAPs usually don't provide the data that an APAP collects or encourage the "hands on" attitude that an APAP can.

Two straigh CPAPs that do have all that data:
Respironics Pro 2

Puritan Bennett GoodKnight 420S

O.

[Snoredog]

oz wrote:

Two straigh CPAPs that do have all that data:
Respironics Pro 2

Puritan Bennett GoodKnight 420S

Correction to the above:
Remstar Pro2 DOES record ALL sleep data just like the autopap model.
However, the PB-420S does NOT report ALL sleep data, reports are very LIMITED, only compliance data, not worth spending extra over the G model in my opinion.

Now the 420E model records ALL sleep data and actually records more info than any other autopap on the market that I've seen, only problem is interpreting said data where it is actually useful.

[Sleepless on LI]

I am no scientist, nor do I full understand to this day the workings of therapy and why we react to all of this individually, but I know we do. That being said, I have done many an experiment over the course of this past year and have to say, straight cpap gives me the best results and makes me feel most alert. That is the up side of cpap for me. But auto, on the other hand, keeps my negative symptoms at bey better, such as aerophagia and leaks with my mask.

I think there are pros and cons to using each. I prefer to keep using the cpap for the sake of feeling better mentally, but there are times I do switch to auto to give my poor stomach a break from all that air. My two cents worth.

[ozij]

The Puritan Bennett GoodKnight 420E CPAP includes the following features:


Smallest, lightest CPAP on the market.
SilverLining Data Management software option to download compliance and session data.

The Puritan Bennett GoodKnight 420S CPAP includes the following features:


Smallest, lightest CPAP on the market.
SilverLining Data Management software option to download compliance and session data. (Software is sold separately.)

The GoodKnight® 420 CPAP System is the smallest and lightest continuous positive airway pressure (CPAP) device on the market. It is designed to help active sleep disorder patients preserve their lifestyles while complying with their prescribed therapy. The GoodKnight 420S model records up to 600 sessions of date/time usage data. It also detects persistent residual apnea, hypopnea and snoring events that occur at set-pressure, allowing appropriate adjustments to therapy.

My empahsis, source: Pruitan Bennett product description. http://www.puritanbennett.com/prod/Prod ... S2=&id=257

[SnoreNoMore2005]

I have switched from 7 - 12 APAP to 8 CPAP per my sleep doc's suggestion and have used it for three months which I think is a pretty good length of time for a test. My Flow Limitation Index has dropped to 0 using CPAP on the first night and has registered 0 ever since. It was not high with APAP (.6), but I think 0 is better than .6. Overall my numbers which were pretty good (1+- AHI) have remained about the same, but I do think I'm sleeping a little better so I plan on staying on CPAP for the time being.

Whether my sleep doc's theory about your brain having to make constant adjustments for your changing respiration with APAP is true or not, I don't know. I suggest those with APAP who know what their mode range is could give the CPAP mode a try if interested.

SnoreNoMore2005

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, APAP

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, APAP

[Sleepless on LI]

I find straight cpap the best for me, too. 10 is my number and I stick with hit.

Hope your rest stays as good as it has been. Congrats on the success.

[Snooter]

Derek,

I’m an engineer and deal with measuring data for a living. MHO is that your AHI data maybe significantly meaningless. I’m not sure what the difference between 0.5 AHI and 2.5AHI. For example let’s say that when you are at 0.5AHI each event is 35 seconds long and when you are at 2.3AHI each event is 10.1 seconds long. What does that mean? I would tend to believe that if you are in the 1 to 2 or 3 AHI range you are doing pretty good.

Which leads to my question. Other than being a loud snorer what is wrong with have a high AHI? I had a sleep study done about a month ago and have an AHI index that is 54 but my oxygen level never drops below 94%. I feel somewhat rested each morning and average about 7 hour sleep during the week and some makeup time on the weekend. My apnea events averaged 14 seconds, but had they lasted 9.9 seconds they wouldn’t count or if my average was 30 seconds I would have the same AHI reading.

I’m scheduled to see and ENT next month. Hopefully he can shed some light on this subject.

Good luck.

Snooter

[Guest]

Which leads to my question. Other than being a loud snorer what is wrong with have a high AHI?

Snooter, I'm not derek, but I can supply a bit of information.
The AASM defines an apnea as cessation of airflow for at least 10 seconds. Desats aren't a component of that definition.
A high AHI such as 54 is defined as severe OSA. Other than being a loud snorer, complications of OSA include, among other things, increased risk for hypertension, 4x higher rate of stroke, coronary artery disease, congestive heart failure, atrial fibrillation, myocardial infarction, diabetes, depression, sexual dysfunction and death.

There's more, but I suddenly feel the urgent need to get to bed and put on my mask...

[Guest]

I think your doctor is trying to brainwash you

I also think a lot of autopap users are confused about autopaps. If your pressure is less than 10cm to 12cm you really don't need an autopap.

Purpose for an autopap are:

- best machine for long term use, can run in cpap mode.
- those wanting to take control over their own therapy.
- have frequent positional/weight changes.
- wanting to confirm cpap therapy pressure without spending another $3k on a new titration study (not everyone has insurance)
- detailed reports to track your progress and fine tune settings.
- results in fewer doctor visits

Breathing against 10cm or even 12cm pressure is fairly easy even without cflex.

Ideal use of the autopap is to:

-Use the machine in autopap mode to find your 90-95% pressure then set the machine to cpap mode with that pressure.
-Still can generate detailed reports to confirm and track therapy progress.

Another good machine is the Remstar Pro2, it records all data like the auto and you can view your results using the optional software. But the price difference is minimal and the autopap offers greater function.

[Guest]

Which leads to my question. Other than being a loud snorer what is wrong with have a high AHI?

Snooter, I'm not derek, but I can supply a bit of information.
The AASM defines an apnea as cessation of airflow for at least 10 seconds. Desats aren't a component of that definition.
A high AHI such as 54 is defined as severe OSA. Other than being a loud snorer, complications of OSA include, among other things, increased risk for hypertension, 4x higher rate of stroke, coronary artery disease, congestive heart failure, atrial fibrillation, myocardial infarction, diabetes, depression, sexual dysfunction and death.

There's more, but I suddenly feel the urgent need to get to bed and put on my mask...

[Guest]

oz wrote:

Two straigh CPAPs that do have all that data:
Respironics Pro 2

Puritan Bennett GoodKnight 420S

Correction to the above:
Remstar Pro2 DOES record ALL sleep data just like the autopap model.
However, the PB-420S does NOT report ALL sleep data, reports are very LIMITED, only compliance data, not worth spending extra over the G model in my opinion.

Now the 420E model records ALL sleep data and actually records more info than any other autopap on the market that I've seen, only problem is interpreting said data where it is actually useful.